Plans unveiled to devolve control of health and social care

Primary care trusts, strategic health authorities and regional
directors of health and social care will be at the heart of plans
to devolve power and funding to local communities in the delivery
and development of local services, according to a major department
of health consultation paper, writes Jonathan

“(PCTs) will be the lead NHS organisation for partnership
working with local authorities and other partners,” the paper says,
proposing that they will receive 75 per cent of total NHS revenue
allocation “to secure the provision of services by 2004”.

The paper adds: “PCTs will work as part of local strategic
partnerships to ensure co-ordination of planning and community
engagement, integration of service delivery and input to the wider
government agenda including Modernising Social Services, Sure
Start, Community Safety, Quality Protects, Youth Offending Teams
and Regeneration Initiatives.”

At a recent Local Government Association conference, DoH
permanent secretary and NHS chief executive Nigel Crisp trailed the
paper’s proposals.

“PCTs will be the real link for local authorities,” said Crisp,
explaining that decentralisation of control from government to
frontline services would mean a “really powerful role for

With 160 PCTs already in existence, a further 150 are due to
become operational from April next year, while at the same time 30
strategic health authorities (SHAs) will replace the 95 existing
health authorities, taking over responsibility for strategic
leadership and performance management.

The plans to devolve power locally have already seen the
department of health announce its restructuring around 12
directorates and a single top management team for health and social

The paper proposes that the eight NHS regional offices will be
abolished and replaced from April 2003 by four regional directors
of health and social care who will oversee the development of local
services. However, the 30 SHAs will inherit the performance
management functions previously carried out by the regional

The new directors will be based in the government offices for
the regions, covering London, the south, the midlands and the
north. Their key functions will include supporting senior DoH staff
in assessing performance; managing the appointment, development and
succession planning of senior management staff; supporting
ministers through casework and local intelligence; and

“Regional directors of health and social care will not be simple
replacements for regional offices,” the paper stresses.

The Association of Directors of Social Services cautiously
welcomed the consultation, saying future power arrangements, not
partnerships and joint working themselves, were the key issue.

John Beer, ADSS social inclusion and health committee
chairperson, said: “Clearly the way in which the SHAs will operate
remains to be seen. One wants them to develop a better relationship
between health and social care, but one that focuses on the
preventive agenda and the promotion of good public health.”


Consultation on proposals to 7 September

July 2001 – publish National Human Resources Framework

August to October 2001 – appoint first wave of PCT chief

September to November 2001 – consult on strategic health
authority boundaries; appoint chairpersons (designate) and chief
executives (designate) for SHAs

December 2001 – agree boundaries for SHAs

January 2002 – appoint second wave of PCT chief executives

April 2002 – establish SHAs and disestablish existing health
authorities; new PCTs become operational

April 2003 – establish new offices of regional directors of
health and social care








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